Optimal timeline for emergency surgery in patients with strangulated groin hernias

Abstract

This retrospective study evaluates the clinical course and outcomes of patients who underwent surgery for strangulated hernias. Among 520 groin hernias from 2001 to 2012, 51 inguinal and 42 femoral hernias were strangulated and operated emergently at a tertiary referral center. Perioperative factors, patient profiles, and time interval to surgery (T total=time from onset to surgery, T 1=time from onset to initial evaluation, T 2=time from the first hospital to the tertiary center, T 3=time from admission at the tertiary center to surgery, T total=T 1+T 2+T 3) were analyzed in patients with strangulation, then compared between two groups, the bowel resection (BR) group and the non-bowel resection (NBR) group. T 1, T 2 and T total in the bowel resection group were significantly longer than those in the non-bowel resection group (P<0.05). Patients who presented initially to the tertiary center (T 2=0) had a significantly lower resection rate than patients transported from other hospitals (24 vs. 44%, P=0.048). There was no significant difference in morbidity between the BR and NBR groups (35 vs. 24%, P=0.231). The elapsed time from onset to surgery, especially T 1 and T 2, is the most important prognostic factor in patients with strangulated groin hernias. Early diagnosis and transportation are essential for good outcomes.